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125949 Diagnostic accuracy and aetiological landscape of third cranial nerve palsy in children
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125949 Diagnostic accuracy and aetiological landscape of third cranial nerve palsy in children
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Journal Article
125949 Diagnostic accuracy and aetiological landscape of third cranial nerve palsy in children
2025
Overview
Third cranial nerve (CNIII) palsy in children has various aetiologies, including congenital, traumatic, and acquired. Diagnosis and management varies according to age, characteristics of presentation, and associated signs and symptoms. The aim of this audit was to review children (<16years) diagnosed or referred with CNIII palsy, assess diagnostic accuracy, and evaluate treatment strategies.A retrospective audit was conducted at Moorfields Eye Hospital NHS Foundation Trust. Magic XP tool was used to identify children (<16years) referred with suspected CNIII palsy between 01/09/2009 and 31/12/2023. Data on the aetiology, misdiagnosis, ptosis, pupillary involvement, and treatment strategies, were collected.145 cases were identified. 75/145(52%) were definitively diagnosed with CNIII palsy. Misdiagnosis occurred in 69/145(48%) cases. Common misdiagnoses included ptosis and physiological anisocoria. Among the confirmed cases, 42/75(56%) were congenital and 24/75(32%) were acquired. Trauma was the commonest acquired cause (25%). Ptosis was documented in only 51% of cases, and pupillary involvement in 29%. Treatment strategies included surgery (22), patching (9), medication (4), refractive error correction (4), Botulinum toxin (1), and cosmetic contact lenses (1).We identified significant misdiagnosis rates and inconsistencies in documentation, particularly regarding ptosis and pupillary involvement, which are both poorly documented in children. This has significant implications on diagnostic and treatment pathways. Improved consistency in documentation is crucial for early accurate diagnosis and management.This large case series highlights the difficulties in assessing children, and the audit cycle highlighted gaps in documentation. However, to improve care in paediatric CNIII palsy, there is a need to standardize diagnostic criteria and documentation practices.
Publisher
BMJ Publishing Group LTD
Subject
